Marcadores ultrassonográficos e resultados perinatais adversos em fetos portadores de gastrosquise simples e complexa
Data
2024-09-24
Orientadores
Araújo Júnior, Edward 
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: o objetivo desse estudo foi avaliar a associação entre marcadores ultrassonográficos de fetos com gastrosquise e desfechos neonatais adversos. Métodos: trata-se de um estudo de coorte retrospectivo que incluiu na análise estatística 46 recém-nascidos com gastrosquise que tiveram assistência pré-natal e parto entre 2009 a 2019. As variáveis observadas incluíram dados sociodemográficos, dados ultrassonográficos, dados de nascimento e os respectivos resultados neonatais. Os testes de normalidade D'Agostino e Pearson foram utilizados para analisar se os valores apresentaram distribuição Gaussiana. O teste de Mann Whitney foi utilizado para comparar as variáveis de distribuição não paramétrica entre os grupos. O teste T Student foi utilizado para comparar as variáveis de distribuição paramétrica entre os grupos. O teste Qui quadrado foi utilizado para avaliar a associação entre os grupos e variáveis categóricas. A regressão logística binária foi utilizada para determinar os melhores preditores gastrosquise complexa e desfechos perinatais adversos. A razão de chances (OR) para o desenvolvimento gastrosquise complexa e desfechos perinatais adversos com diferença estatística entre os grupos foi determinada por regressão logística binomial stepwise. Resultados: após o nascimento, 78% gastrosquises foram classificadas como simples e 22% como complexas. Foi observado associação significativa entre o tipo de gastrosquise e a prevalência em primigestas, sendo as gastrosquises simples mais prevalentes nesse grupo (40,0 vs 77,8%, p=0,022). Não foi observado efeito significativo do tipo de gastrosquise sobre idade materna (p=0,658), índice de massa corporal (p=0,877), número de gestações (p=0,096), etnia (p=0,706), uso de drogas (p=1,00), uso de antinflamatório não esteroidal/ácido acetilsalicílico (p=0,591), uso de anticoncepcional oral (p=0,971), infecção sexualmente transmissível (p=0,432) e infecção do trato urinário (p=0,482). Os fetos com gastrosquise complexa apresentaram peso fetal estimado durante o exame de ultrassonografia significativamente menor que aqueles com gastrosquise simples (1907,0 vs 2171,0, p=0,040, respectivamente). Não foi observado efeito significativo do tipo de gastrosquise sobre a medida do índice de líquido amniótico (p=0,137), diâmetro da alça intra-abdominal (p=0,089), diâmetro da alça extra-abdominal (p=0,092), espessura da alça intestinal (p=1,00) e diâmetro da abertura do defeito (p=0,158). Os recém-nascidos com gastrosquise complexa, apresentaram maior prevalência de óbito neonatal precoce, quando comparados aos recém-nascidos com gastrosquise simples (30,0% vs 2,8%, p=0,007, respectivamente). A medida da abertura do defeito associou-se a sepse neonatal [X2: 6.31 (1), OR:0,92, IC95% (0,85-0,98), p=0,020] e a presença de gastrosquise complexa [X2: 7,33 (1), OR: 23,25, IC95% 1,92- 280,77, p=0,013] foi o único preditor significativo para óbito neonatal precoce. A presença de gastrosquise complexa aumenta o risco óbito neonatal precoce em 23,25 vezes. Conclusões: gastrosquise complexa esteve associada a redução na necessidade de nutrição enteral e aumento do risco de óbito neonatal precoce. A medida de abertura do defeito se mostrou um preditor significativo para sepse neonatal em ambas as gastrosquises simples e complexas.
Objectives: the objective of this study was to evaluate the association between ultrasound markers of fetuses with gastroschisis and adverse neonatal outcomes. Methods: This is a retrospective cohort study that included in the statistical analysis 46 newborns with gastroschisis who had prenatal care and delivery between 2009 and 2019. The variables observed included sociodemographic data, ultrasound data, data on birth, and respective neonatal outcomes. The D'Agostino and Pearson normality tests were used to analyze whether the values presented a Gaussian distribution. The Mann-Whitney test was used to compare nonparametric distribution variables between groups. The Student's T test was used to compare parametric distribution variables between groups. The Chi-square test was used to evaluate the association between groups and categorical variables. Binary logistic regression was used to determine the best predictors of complex gastroschisis and adverse perinatal outcomes. The odds ratio (OR) for developing complex gastroschisis and adverse perinatal outcomes with statistical differences between groups was determined by stepwise binomial logistic regression. Results: after birth, 78% of gastroschisis were classified as simple and 22% as complex. A significant association was observed between the type of gastroschisis and prevalence in primiparous women, with simple gastroschisis being more prevalent in this group (40.0 vs 77.8%, p=0.022). There was no significant effect of the type of gastroschisis on maternal age (p=0.658), body mass index (p=0.877), number of pregnancies (p=0.096), ethnicity (p=0.706), drug use (p= 1.00), use of non-steroidal anti-inflammatory drugs/acetylsalicylic acid (p=0.591), use of oral contraceptives (p=0.971), sexually transmitted infection (p=0.432) and urinary tract infection (p=0.482). Fetuses with complex gastroschisis had a significantly lower estimated fetal weight during ultrasound examination than those with simple gastroschisis (1907.0 vs 2171.0, p=0.040, respectively). There was no significant effect of the type of gastroschisis on the measurement of amniotic fluid index (p=0.137), intra-abdominal loop diameter (p=0.089), extra-abdominal loop diameter (p=0.092), loop thickness intestinal (p=1.00) and diameter of the defect opening (p=0.158). Newborns with complex gastroschisis had a higher prevalence of early neonatal death when compared to newborns with simple gastroschisis (30.0% vs 2.8%, p=0.007, respectively). The extent to which the defect was opened was associated with neonatal sepsis [X2: 6.31 (1), OR:0.92, 95% CI (0.85-0.98), p=0.020] and the presence of complex gastroschisis [X2: 7.33 (1), OR: 23.25, 95%CI 1.92-280.77, p=0.013] was the only significant predictor for early neonatal death. The presence of complex gastroschisis increases the risk of early neonatal death by 23.25 times. Conclusions: complex gastroschisis was associated with a reduced need for enteral nutrition and an increased risk of early neonatal death. The defect opening measurement proved to be a significant predictor for neonatal sepsis in both simple and complex gastroschises.
Objectives: the objective of this study was to evaluate the association between ultrasound markers of fetuses with gastroschisis and adverse neonatal outcomes. Methods: This is a retrospective cohort study that included in the statistical analysis 46 newborns with gastroschisis who had prenatal care and delivery between 2009 and 2019. The variables observed included sociodemographic data, ultrasound data, data on birth, and respective neonatal outcomes. The D'Agostino and Pearson normality tests were used to analyze whether the values presented a Gaussian distribution. The Mann-Whitney test was used to compare nonparametric distribution variables between groups. The Student's T test was used to compare parametric distribution variables between groups. The Chi-square test was used to evaluate the association between groups and categorical variables. Binary logistic regression was used to determine the best predictors of complex gastroschisis and adverse perinatal outcomes. The odds ratio (OR) for developing complex gastroschisis and adverse perinatal outcomes with statistical differences between groups was determined by stepwise binomial logistic regression. Results: after birth, 78% of gastroschisis were classified as simple and 22% as complex. A significant association was observed between the type of gastroschisis and prevalence in primiparous women, with simple gastroschisis being more prevalent in this group (40.0 vs 77.8%, p=0.022). There was no significant effect of the type of gastroschisis on maternal age (p=0.658), body mass index (p=0.877), number of pregnancies (p=0.096), ethnicity (p=0.706), drug use (p= 1.00), use of non-steroidal anti-inflammatory drugs/acetylsalicylic acid (p=0.591), use of oral contraceptives (p=0.971), sexually transmitted infection (p=0.432) and urinary tract infection (p=0.482). Fetuses with complex gastroschisis had a significantly lower estimated fetal weight during ultrasound examination than those with simple gastroschisis (1907.0 vs 2171.0, p=0.040, respectively). There was no significant effect of the type of gastroschisis on the measurement of amniotic fluid index (p=0.137), intra-abdominal loop diameter (p=0.089), extra-abdominal loop diameter (p=0.092), loop thickness intestinal (p=1.00) and diameter of the defect opening (p=0.158). Newborns with complex gastroschisis had a higher prevalence of early neonatal death when compared to newborns with simple gastroschisis (30.0% vs 2.8%, p=0.007, respectively). The extent to which the defect was opened was associated with neonatal sepsis [X2: 6.31 (1), OR:0.92, 95% CI (0.85-0.98), p=0.020] and the presence of complex gastroschisis [X2: 7.33 (1), OR: 23.25, 95%CI 1.92-280.77, p=0.013] was the only significant predictor for early neonatal death. The presence of complex gastroschisis increases the risk of early neonatal death by 23.25 times. Conclusions: complex gastroschisis was associated with a reduced need for enteral nutrition and an increased risk of early neonatal death. The defect opening measurement proved to be a significant predictor for neonatal sepsis in both simple and complex gastroschises.
Descrição
Citação
CALDAS, João Victor Jacomele. Marcadores ultrassonográficos e resultados perinatais adversos em fetos portadores de gastrosquise simples e complexa. 2024. 101 f. Dissertação (Mestrado em Obstetrícia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2024.